Current Management of Hyponatremia in Acute Heart Failure: A Report From the Hyponatremia Registry for Patients With Euvolemic and Hypervolemic Hyponatremia (HN Registry)

被引:44
作者
Dunlap, Mark E. [1 ]
Hauptman, Paul J. [2 ]
Amin, Alpesh N. [3 ]
Chase, Sandra L. [4 ]
Chiodo, Joseph A., III [4 ]
Chiong, Jun R. [5 ,6 ]
Dasta, Joseph F. [7 ]
机构
[1] Case Western Reserve Univ, MetroHlth Campus, Cleveland, OH 44106 USA
[2] St Louis Univ, Sch Med, St Louis, MO 63103 USA
[3] Univ Calif Irvine, Irvine, CA USA
[4] Otsuka Pharmaceut Dev & Commercializ Inc, Princeton, NJ USA
[5] Loma Linda Univ, Med Ctr, Loma Linda, CA 92350 USA
[6] MedEx Hlth Network Inc, Redlands, CA USA
[7] Univ Texas Austin, Coll Pharm, Hutto, TX USA
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2017年 / 6卷 / 08期
关键词
acute heart failure; fluid restriction; hypertonic saline; hyponatremia; saline; sodium; tolvaptan; HOSPITALIZED-PATIENTS; NEUROHUMORAL ACTIVATION; INTRAVENOUS MILRINONE; PROSPECTIVE TRIAL; OUTCOMES; TOLVAPTAN; ADMISSION; EXACERBATIONS; PREDICTORS; SURVIVAL;
D O I
10.1161/JAHA.116.005261
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Hyponatremia (HN) occurs commonly in patients with acute heart failure and confers a worse prognosis. Current HN treatment varies widely, with no consensus. This study recorded treatment practices currently used for patients hospitalized with acute heart failure and HN. Methods and Results-Data were collected prospectively from 146 US sites on patients hospitalized with acute heart failure and HN (serum sodium concentration [Na+] <= 130 mEq/L) present at admission or developing in the hospital. Baseline variables, HN treatment, and laboratory values were recorded. Of 762 patients, median [Na+] was 126 mEq/L (interquartile range, 7) at baseline and increased to 130 mEq/L at discharge. Fluid restriction was the most commonly prescribed therapy (44%), followed by no specific HN treatment beyond therapy for congestion (23%), isotonic saline (5%), tolvaptan (4%), and hypertonic saline (2%). Median rate of change in [Na+] varied by treatment (0.5 [interquartile range, 1.0] to 2.3 [8.0] mEq/L/d) and median treatment duration ranged from 1 (interquartile range, 1) to 6 (5) days. Fluid restriction and no specific HN treatment resulted in similar changes in [Na+], and were least effective in correcting HN. Few patients (19%) had [Na+] >= 135 mEq/L at discharge. Conclusions-The most commonly used treatment approaches for HN (fluid restriction and no specific treatment) in acute heart failure increased [Na+] minimally, and most patients remained hyponatremic at discharge.
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页数:10
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